An Excellent Choice

by Emma Brockes

  Anyway, I’m not having more than one baby because I’m not having any babies at all. What I seem to be having is another adverse reaction to the drugs. The Monday after the insemination, I look like I’ve had a large lunch. Two days after that, the swelling has spread to my sides. On Thursday night, I wake up in my bed in the early hours of the morning to the sensation I am drowning on the inside. The water level is halfway up my rib cage and rising. I drag myself to the toilet, throw up for a solid ten minutes and crawl back to bed ready to dial 911. Then I remember I am wearing huge black knickers with holes in the elastic and think, OK, give it five minutes.

  “Oh my god,” says the nurse when I go in on Friday morning. I am lying on the gurney and she is staring, horrified, at my bloated lower half. “You poor thing.”

  “Is this normal?”

  “It happens.”

  “Nobody warned me.”

  That’s not quite true. I remember Dr. B mentioning it, way back before my first round of injections, in the same way drug companies reel off side effects at the end of a commercial, the shortness-of-breath-paralysis-increased-risk-of-certain-types-of-cancer-seizures-and-in-some-cases-death spiel, and which I took with the same level of seriousness. In Britain, it’s illegal to advertise prescription drugs on TV, and whenever I see a U.S. commercial urging consumers to ask their doctor about a particular drug, my baseline British credulity kicks in. Surely, I think, if the drug did any of those horrible things, the authorities wouldn’t let them equate the experience of taking it with a couple having the time of their life on a beach? Surely no one actually gets those side effects?

  Well, apparently they do, and I am one of them. Ovarian hyperstimulation syndrome (OHSS) is an overreaction to the fertility drugs in which the ovaries respond abnormally to an excess of hormones in the drugs and leak fluid into the abdomen. It is very common, says the nurse; about 35 percent of women taking injectable drugs get a mild form of OHSS and experience slight weight gain. In more severe cases, sufferers have to go into the hospital to be drained, and technically it can cause a blood clot and kill you. She carries on eyeing my lower half. “This is . . . quite bad,” she says, but doesn’t think I’m in any immediate danger. Awkwardly, I get up off the gurney and lumber to the subway, walking as if a horse has lately bolted from under me.

  “What are you wearing?” says L that night, catching sight of me sideways on.

  “What do you mean?”

  “Look.” I turn to look at myself in the full-length mirror propped up by her bedroom door.

  “That is insane.” I am so big-to-bursting that it appears, through the thin material of my leggings, as if I were wearing a codpiece.

  “How’s your fat pussy?” she says the following morning.

  “Stop it. You know I hate that word.” (I do, I hate it. It’s a word for men who hate women and the women who love them—a great book title, by the way, for anyone who wants it.)

  “OK.” A minute later she says, “But how is it? Your fat pussy?”

  Later that day, I return to my apartment and log on to my computer to find an e-mail from my friend Leila. “Hiya luv. How’s your fat vag? I’m sorry but that will never, ever not be funny.”

  * * *

  • • •

  YOU CAN’T GET this fat on drugs alone. In all likelihood, the addition of pregnancy hormones has put even more pressure on my ovaries and before I go in for a blood test I know I am probably pregnant. I don’t see this as cause for celebration. Gloomily, I think that I lost the first pregnancy due to blood loss brought on by taking too many drugs and will lose this, the second, due to the extraordinary land mass of my midsection, brought on by taking too many drugs. I buy three over-the-counter pregnancy kits and all three are negative. Still the bloating continues.

  “Congratulations,” says Dr. B on the phone a few days later. I am in the deli buying Gatorade, one of the few things said to bring down the swelling but which, after drinking gallons of the stuff, has succeeded only in making my teeth ache.

  “I’m a genius!” I say halfheartedly. “Or, you’re a genius. One of the two.”

  “It’s early days,” he says sternly.

  “I know. I remember last time.”

  I don’t bask in the news. I don’t walk around Central Park communing joyfully with the cells in my uterus. I don’t even work out the due date and what its star sign might be. Instead, I trudge around my apartment feeling as if I were wearing a space suit, waiting for the pregnancy to fail. Sure enough, a few days later, I go in for an ultrasound and as the nurse moves the wand over my belly she hesitates for long enough to telegraph bad news.

  “I think I see more than one egg sac,” she says eventually.

  “What?”

  She carries on squinting at the screen.

  “How many?” I say. She holds up two fingers.

  “Shit.”

  I look at the screen. For once, I can see what she’s talking about, two dark dots orbited by light.

  “You can see multiples this early?” I say.

  “Yeah.” She smiles. “I’m like the multiples whisperer.”

  Ten minutes later, as I’m handing over my credit card at reception, another nurse sidles up to me, eyes wide. “You know Sophia says she sees two?!” she says.

  “Yeah. How’s her form?”

  “Pretty good.”

  If this had happened any earlier on in the process, I assume I would have freaked out. As it is, I can regard it only as a painful variant on the loss of a single baby this month.

  “WHAT?” says L, who is not in that place. “Oh, no!”

  “It’s probably just a shadow on the ultrasound.”

  “That’s not good,” says L.

  “I know.”

  And I do know, intellectually. All the risks associated with pregnancy increase when you’re carrying more than one baby. Rates of miscarriage, preeclampsia and gestational diabetes go up. Placental abruption, when the placenta separates from the lining of the womb, is more likely to occur. The fetal death rate remains relatively small—1.6 percent of twins and 2.7 percent of triplets are stillborn, compared with 1 percent of single pregnancies—but the babies are more likely to be born prematurely, increasing the risk of cerebral palsy and other birth defects. Given the risk factors, this is why the conception of multiples is so frowned upon by public health bodies. In the last thirty years, both the United States and the UK have experienced sharp rises in the numbers of multiple births—a 75 percent increase in the United States, and 56 percent in the UK—largely as a result of IVF. (This surge is now mostly accounted for by twin births, triple pregnancies having declined in both countries thanks to steps being taken to avoid them.) But while the regulators in both countries acknowledge that this is not a good thing, the American Society for Reproductive Medicine allows that “in the United States, physicians and patients jointly decide how many embryos to transfer.” In Britain, on the other hand, the patient is considered the last person on earth who should be asked how many embryos to transfer, because the answer is likely to be as many as are needed to bring this show to an end.

  At the risk of belaboring the point, in the UK, public health policy is set so stridently against aiding the conception of multiples that, as a friend who’d had treatment back home put it to me, if you’re under thirty-eight and having IVF in the UK, “you have to beg them to put more than half an egg back in.” The Human Fertilisation and Embryology Authority, the industry’s regulatory body, explicitly seeks to “reduce the proportion of multiple births after fertility treatment” and clinics are expected to come up with a “multiple births minimization strategy.” No distinction is made here between the conception of twins and triplets; a multiple pregnancy of any kind is considered the biggest risk associated with assisted fertility and an overall bad business for mother and child.

  I know all of this. And ye
t the only figure that concerns me is 27 percent: that is, the percentage of twin pregnancies that result in the miscarriage of at least one baby. My willingness to reassure L that, not only will the twins thing probably come to nothing but that I feel about it precisely as she does, is a false emphasis that makes me feel as shifty as one of those British bankers in the Far East who run up millions of dollars of debt and hide the receipts in their desk drawers until the entire economy is brought down. I don’t want twins. Of course I don’t. How could I? How would I begin to manage? It would be absurd, embarrassing. And yet the threat of losing them sets off a drumbeat in my brain that nothing I do will extinguish: mine-mine-mine-mine.

  A few days later, I am having another blood test at the clinic when I hear a commotion in the corridor outside. The nurse excuses herself and a moment later I hear her colleague exclaim, “Mrs. X—triplets!” Then I hear what sounds like a high five.

  “Someone’s pregnant with triplets?” I say when she comes back in. She looks embarrassed.

  “We’re not supposed to say—but, yes.” She beams. “After IVF. We put back two fertilized eggs and one split.”

  “That’s terrible. What a nightmare.” The nurse smiles at my naïveté, and for a moment I am jolted back to my pretreatment self. Of course. In a for-profit industry, one in which pregnancy is the only measure of success, high-order multiples start to look like the jackpot. Depending on how long she has been trying to get pregnant, the woman in question is probably half split between horror and helplessly declaring them hers.

  Sure enough, twenty minutes later, while Sophia does the ultrasound, my clarity on this subject has flown out of the window and all I can think is how devastated I will be when it turns out one or both embryos has gone. Sophia peers at the screen. “You see? Two egg sacs,” she says. She carries on peering. “Oh. Oh.” Her face freezes. “OK, I’m not going to frighten you.”

  “What do you see?” There is a long pause.

  “Be fairly confident you’re frightening me. What do you see?”

  “There’s another small spot in the uterus, here.” She peers some more and then comes briskly to her senses. “It’s waaaay early. We’re not going to panic. You can get dressed now.”

  As I’m getting dressed, another nurse comes in, picks up my chart and says “Oh!” Sophia shoots her a look. “It’s waaaaaay early, so we’re not going to panic her,” she says.

  Dr. B is away that week and it is his colleague, Dr. M, who takes the consultation. Dr. M is urbane, tanned, unrufflable. He looks like a man from a yacht commercial. My brain has gone into lockdown, working along the lines that if I don’t get the information, the information doesn’t exist. So I sit down in his office and say nothing.

  Dr. M browses my notes with the mild interest of a man reading the racing papers. “Remind me how old you are?” he says.

  “I’m thirty-eight. I’ll be thirty-nine when I deliver—getting up there.”

  The doctor snorts. “Are you kidding? In New York, that’s practically pediatrics.” He carries on reading. “Your levels look good. They’re consistent with a healthy single pregnancy or, at most, twins.” He says this as if it were no big deal, the difference between, say, picking up one can of tuna at the supermarket or two.

  “Twins,” I repeat.

  “It’s quite common with IUI; a few more fertilize for insurance and never develop.” The idea that I might be “getting away” with “at most” twins is too mad to fathom. “So I shouldn’t panic?” I say meekly. Perhaps, after all, I have misunderstood. Dr. M walks me to the door.

  “No!” He gives me a jovial pat on the shoulder. “Don’t worry about this business of there being four in there. Let’s see where we are this time next week!”

  I am due to have lunch with Oliver that day and call him when I get into the street.

  “Everything all right?” he says.

  “Everything’s fine. Although I should warn you I’m going to be ordering the onion rings and the cheese fries. I’m eating for five.”

  Oh, god. What on earth am I going to tell L?

  * * *

  • • •

  YOU HAVE TO IMAGINE the worst-case scenario and work your way backward. This is Oliver’s philosophy, an exercise in what he calls pessimism and I call optimism but that either way works on the assumption that by rehearsing the worst, one is able to neutralize its power. I am very good at rationalizing my fears, failing which, denying them, but Oliver is even better at this than I am. If there was a world championship in it—“Your friend learns she is pregnant, probably-with-twins-but-possibly-with-quads; you have five minutes to reframe her anxiety as a philosophically nonsensical position. Your time starts . . . NOW”—Oliver would win.

  “One day you’ll laugh about this,” he says at the diner.

  “I’m already laughing about it.” As I say this, I can hear the slight ring of hysteria at the edge of my tone. “Can you imagine how much this is going to cost?” Not only does my insurance fail to cover fertility treatment, but the wording of the policy states that it doesn’t cover “the side effects” of fertility treatment. “Do you think that includes having quadruplets?”

  “I think it’s too early to panic.”

  “That’s what the nurse said. But there’s nothing to panic about. I’m not having four. They’ll have to get rid of—” Here I stop. How many—one? Two? Three? There are, I know, doctors who believe wholeheartedly in abortion but have reservations about reducing multiple pregnancies and not only because it risks triggering a universal miscarriage. The distinction between aborting a single fetus and aborting one of two, three or four makes no sense ethically, but there it is, raising the specter of a “missing” sibling and throwing weird light on the lottery element via which one embryo is destroyed and another is “allowed” to remain. As my friend Dan says to me a few days later, “What if you are pregnant with twins and you abort Einstein and keep Hitler?” (“You think I’m pregnant with Einstein and Hitler?” I say.)

  I don’t mention the possibility of quads to Dan. It is too shaming, too weird. Two are, depending on one’s view, either bad luck or a gift from god. Four are straightforwardly a freak show.

  “You could just go to England at the last minute and have them on the NHS,” says Oliver, dragging a French fry through a puddle of ketchup.

  “Yeah.”

  “Or the even-more-last-minute option.”

  “What?”

  “BA flight crew. Trained to deliver babies, apparently.”

  “Good thinking.”

  “To fly, to serve.”

  I don’t call L at work to tell her the news. I wait until that evening, when we’re together at her apartment. Afterward, she is very quiet. The threat of quadruplets, even if the levels are more consistent with twins, is so insane, so hideous, that the only possible response is sympathy. I can sense her mind hovering like a cursor over the thing I have been thinking all day: that this means I will almost certainly miscarry and have to start all over again.

  On the phone the next morning, I tell my dad I’m pregnant without going into the details.

  “Oh, love. Congratulations,” he says.

  “It’s very early days,” I say severely.

  “Of course. So it’s not multiples, then?!” My dad is well up on the lingo by now, but it is clear from his tone he is joking.

  “Um, well, it might be two.” There is a long silence. “But it’s probably one.”

  “Wow.”

  To myself, I repeat, “It’s probably one.” To the few people I tell it might be two, I say “total nightmare!” because this is what I am expected to say. It is a nightmare. Single-mother-of-twins sounds like a cosmic joke, a punishment for the hubris of trying to cheat Mother Nature. But while I am shocked and appalled and terrified and the rest of it, there is a different beat still drumming away. In the quiet of my apar
tment and on the subway to L’s, when I wake up and when I lie down at night: mine-mine-mine. It starts earlier than we know it, the body’s defense of its own machinations, and way down deep in my bones I am cheering them on.

  TEN

  Rising

  AS PROMISED BY DR. M, two of the four shadows on the ultrasound disappear inside of a week and it is confirmed that “only” two embryos remain.

  “Two!” cries Dr. B, back from his holiday and leaping out of his chair as I come through the door. He holds up two fingers in a gesture of victory. “Two!”

  It is hard to know, in this moment, what to panic about most: the prospect of losing them both, the prospect of having them both, or my doctor’s maniacal joy. I smile censoriously.

  “What’s the matter?”

  “I feel like a minority shareholder in my own body.”

  “Ah.” He beams and points in the air. “But you have the deciding vote.”

  That night in L’s apartment, I break the good news: that two of the four embryos have gone.

  “So there’s still two in there?” she says.

  “Seem to be. For the time being. But, you know, it’ll probably . . .”

  “I’m going to have another one,” she says abruptly.

  “Good. Do.”

  “I will.”

  “You should.”

  It’s not just that the balance between L and me will be upset if I have two. It’s the discreet sense of one-upmanship between a woman with two children and a woman with one. We are rational people but we are not immune, L and I, to the cultural cues telling women that children are currency. I am pregnant with twins, ergo I have, in some sense, done better than if I were pregnant with a single baby, and from now on, every pregnancy ache, every complaint I make, will rest on the presumption of greater suffering.